Tuesday, May 18, 2010

Intervew with Chris Kresser of The Healthy Skeptic

Last week, I did an audio interview with Chris Kresser of The Healthy Skeptic, on the topic of obesity. We put some preparation into it, and I think it's my best interview yet. Chris was a gracious host. We covered some interesting ground, including (list copied from Chris's post):

The little known causes of the obesity epidemic

Why the common weight loss advice to “eat less and exercise more” isn’t effective

32 comments:

You mention mushrooms in your interview discussion about prebiotic foods, though I can't seem to find many other good references suggesting that they contain fermentable fibers. Are they less "effective" than, say, Jerusalem artichokes?

Ayers at Cooling Inflammation suggests tomatoes and apples for pectin to "feed" bacteria -- is this a functionally similar recommendation?

Could you give us a link or some info to help with a search for the studies about the increasing obesity in mice in subsequent generations (the hypothalamic inflammation theory stuff)? I'm trying to make that notion make sense to me and I could use more information. thanks for the interview!

As for sugar it could be the fructose or the glucose or what the body has to do to break the bond between the two or the fact that it is an empty calorie.

Animal studies have shown that they will eat not so much to calories or even volume, but to nutrients. They will eat huge amounts of calories and huge volumes of food until they have gotten enough nutrients.

Wheat starch (white flour), is made of long chains of glucose. The only thing that sugar and white flour have in common is that they are empty calories and rich sources of glucose. But of course, it's entirely possible they are bad for different, not the same, reasons.

As a trainer and movement therapist, finding solid, verifiable, and purely scientific information regarding nutrition is very difficult to find (for many obvious reasons). Your blog, however, has been one my main sources for fantastic info. I would like to thank you on behalf of my clients for all your hard work and effort in educating the public about something so vital to a high quality life. I am also fighting the good fight and helping people understand the importance of correct movement patterns coupled with proper posture protocols. Best of luck and great interview!

Much appreciated. A 'big-picture' audio interview like this helps those people who aren't willing to wade through dozens of websites and books. I have sent a link to the interview to several of my family members.

I had a lot of fun with it, and it's a nice break from writing articles so I'm planning to do a few more in the near future. Topics may include diabetes and dysglycemia, thyroid health, high-intensity strength training and more on weight regulation.

There is so much conflicting information about fiber that sifting through it all can be quite frustrating. Dr. Harris on Panu suggests that limiting fiber is beneficial for those with IBS or other inflammatory gut disorders (this jives with a few other noted low-carbers), but I'm seeing more and more information that suggests gut flora health is essential to TOTAL health (Ayers, here, et al). Is there a way around this impasse? I'm very interested in how to achieve gut health to the maximum extent without inadvertently damaging its function.

Fiber can indeed aggravate IBS, GERD and most other G.I. conditions because they are often caused by dysbiosis. Fiber feeds both good and bad bacteria, and if you have an imbalance of bad bacteria fiber could worsen your symptoms.

This is why a low-carb diet with a reduction of fibrous vegetables can be helpful, at least initially, in these cases.

However, this is just a symptomatic approach as it doesn't address the underlying cause (dysbiosis). So this diet should be combined with consumption of fermented foods and/or probiotic supplementation. This must be done SLOWLY. Most people who take probiotics go too fast and give up because they get gas or bloating. It's essential to start with a very small amount and build gradually over time.

Once the gut flora is starting to balance, it should be possible to add some fiber back into the diet. Especially important are prebiotic foods or supplements, because these preferentially feed the good bacteria in the gut. Once again, this has to be done very slowly and carefully because prebiotics can cause gas and bloating as the gut flora adjusts.

Great interview Chris and Stefan! Stefan, could you tell me how (source) and in what amounts one should be consuming pre and pro-biotics? Other than those commercially advertised yogurts that use it as a selling tool, I don't want all the sugar that comes along with those products. Are they something you can purchase whole as an additive? Thanks again for an amazing podcast! Looking forward to more info in this format from Chris. Really interested in the upcoming one on the thyroid. So easy to listen to while driving. :-)

My opinion is that it's preferable to get probiotics from foods when possible. The potency is generally much higher in foods and there's some reason to believe they're more protected against stomach acid than the supplements. This would include yogurt, kefir, raw sauerkraut, raw kim-chi, kombucha, beet kvass, and more.

I recommend making them at home. It's easy and cheap. The best book on the subject is called Wild Fermentation by Sandor Katz.

As far as store-bought brands, I think Helios is the best brand of kefir, and Strauss is the best brand of yogurt (if they have these in your area). Plain, whole milk is best of course. Health food stores will also generally carry raw kombucha and sauerkraut in the refrigerated section as well. Note that this sauerkraut is different than what you'd find in the condiments section (unrefrigerated).

Prebiotics are a bit more difficult. As Stephan mentioned, they can be found in jerusalem artichokes, jicama, burdock, onions and leeks. In the case of prebiotics I suggest a supplement. The one I prescribe to my patients is unfortunately only available to health care practitioners, but just look for products with inulin and FOS. Jarrow has one that looks decent.

Im pretty sure the Gut Flora is the explanation for why some thin people find it really hard to put on weight.

A zero-carb, zero fibre diet will no doubt reset the gut flora colonies to a balanced constant (after how long?), from that point its then up to us to make sure we eat foods that get the good colonies to population explode.

Ive always wondered why Human Saliva contains so much amalyse, people think its because starch vegtables played an important role in evoltionary human history, but im actually thinking the real reason is so we can quickly and preemptively digest the starch and absorb it in the small intestine before we 'miss' it and it gets to where the bad gut flora are and feeds them instead!

Now we just have to figure out exactly what micro-nutrients the good and bad flora like to feed on...

While it is definitely a good idea to regularly consume a wide variety of probiotic and prebiotic foods, I agree it's best to pass on the commercial "probiotic" enhanced processed products that are popping up everywhere these days - in both conventional supermarkets as well as in "natural" food stores like Whole Foods. A quick look at the labels invariably shows these products are loaded with various added sugars, often highly processed non-fat dry milk solids instead of plain whole milk, and various other highly processed ingredients I'd rather not feed my family.

Instead, I focus on serving foods that are naturally probiotic and prebiotic instead of relying of a manufacturer's "enhancements" to over processed packaged foods. I serve lacto-fermented pickles and sauerkraut instead of the conventional vinegar variety (LF pickle relish is easy to add to salads (egg/tuna/chicken/turkey/ham and green salads) as well as to homemade salad dressings and mayonnaise-based sauces (tartar sauce, Herbes de Provence caper-lemonnaise, homemade ketchup-mayo "special spread", etc.). My son doesn't like sauerkraut (yet) but he happily consumes homemade salad dressing that includes a bit of sauerkraut juice in place of vinegar ;-).

I second the recommendation on Wild Fermentations for making lacto-fermented foods at home. If that seems too daunting, some items that are easy to use frequently (as condiments) can often be found at conventional supermarkets (Bubbies brand of sauerkraut, dill pickles, and dill pickle relish, for eample - check Bubbies website for local stores or ask your store manager to carry it).

A subscription box of local produce from a local CSA (www.localharvest.org/CSA) is a great way to continually consume fresh, seasonal, and local prebiotic foods (our box regularly provides our family with a variety of delicious prebiotic-containing greens, leeks, onions, scallion, herbs, apples, and so on. Lately I've been blending the extra parsley, carrot, chard, and beet greens into smoothies with raw egg yolks, coconut milk and heavy cream (sometimes with some added hibiscus ginger green tea), I can tell my inner garden is really benefiting (I adopted this habit slowly to allow my gut buddies to adjust).

Increasingly I've been adding various seaweeds to the family meals (though you'd have to look hard to find most of it). I use kombu when simmering bone broths; various slivered, diced, and ground dried sea vegetables/kelps as a seasoning and garnish (looks like ground pepper or minced herbs); as well as outright larger pieces of sea vegetables as a salad or added to green salads. Sea vegetables can be purchased fresh in salt-packed pouches (the sea vegetables stay fresh a long time in the salt, which is easily rinsed off before serving) or they can be purchased economically dried, and then reconstituted in some water before draining and serving. The sea vegetable component to our meals has been a gradual inclusion over the past two+ years (initially for the iodine content), but now I reach for some form of sea vegetable at least once or twice daily, even if it's simply a couple shakes of a finely ground sea vegetable/sea salt seasoning mixture, aka "Mendocino Miracle Mix". If you think your family will not take to eating "seaweed", it's best to say little for a while and ease into it, starting with the minced dried forms that are used more like herbs.

Hope that gives you some ideas on how to include probiotic and prebiotic foods in your family's diet - it's more economical in the long run this way, too, than buying the product that enhances Jamie Lee Curtis' income ;-).

Two responders have recommended the book Wild Fermentations. The user reviews of this book on Amazon are, shall we say, mixed. Apparently the author includes a lot of information about his unusual lifestyle, something some reviewers find very objectionable. Others complain that the book is disorganized and hard to use and say that information as good is easily found free on the internet. I don't have first hand information either way, but people thinking of buying the book might want to consider these user opinions and do a little looking around of their own.

Excellent interview -- way beyond "carbs are evil" pablum. Unfortunately, the end was truncated around where you were discussing gluten. My friend has type 2 diabetes, but is addicted to grains, so I was looking for the least bad grain to recommend to him. I think a previous post mentioned that rye had fewer leptin-blocking lectins. But I'd like to know what grain you dislike least (assuming that it's embodied as whole grain bread, as few people have the time or initiative to make traditionally prepared grain foods). In any event, thanks for sharing all these unintuitive routes to metabolic regulation.

Yeah, I would suspect that the lower lectin level of rye (vs. wheat) combined with (perhaps) some fermentation relating to the sour milk, would make sourdough rye less bad than other breads. I will suggest it to him, as I know he has access to it at the store. And I'll remind him of about the severe ills of wheat.

By the way, I researched Stephan's comments about aspirin inhibiting type 2 diabetes. The study I found said that the amount of aspirin required would be toxic. But then, this article theorizes that NF-kB in the liver single-handedly launches type 2 diabetes (yeah, I kind of doubt that, but perhaps it's a key component). I wonder if intravenous curcumin would then shut it down. (Curcumin is an NF-kB inhibitor which apparently doesn't cross the intestines easily, but would probably be nontoxic at therapeutic doses, and could likely be made more bioavailable.)

Your MP3 link does indeed contain the whole interview. You guys ran circles around what most MDs know about metabolic dysfunction. Please do this again when the two of you have more insights to share!

I was at a seminar last weekend on autoimmune physiology and the presenter made some interesting connections between gluten sensitivity and diabetes.

He said that very often people with gluten sensitivity have antibodies to other tissues. In his practice he frequently sees antibodies to GAD (glutamate decarboxylase). GAD is responsible for converting glutamate to GABA, but is also expressed in the pancreas and plays a role in insulin release.

These patients with GAD antibodies will have symptoms that mimic (and are often misdiagnosed as) type 2 diabetes. The correct diagnosis would be latent autoimmune diabetes, but the point is that he's seeing this pattern fairly regularly in patients with gluten intolerance and other autoimmune conditions.

Food for thought, eh?

After I finish my series on thyroid (which is next up after the current EFA and fish/fish oil series), I'll be writing about diabetes.

Interesting... I'd never heard of an autoimmune condition resulting in latent diabetes (and presumably parasympathetic dysfunction, as it affects GABA).

I'm looking forward to your fish oil discussion. If I recall, Dr. Rosedale of low-carb fame claimed that EPA oxidation is a major contributor to aging. I've always wondered whether we shouldn't just take DHA alone. I'll have to study your report...

Paul said... “Animal studies have shown that they will eat not so much to calories or even volume, but to nutrients. They will eat huge amounts of calories and huge volumes of food until they have gotten enough nutrients.”

About Me

I'm a writer and science consultant with a background in neuroscience and obesity research. I have a BS in biochemistry and a PhD in neurobiology. I'm the author of "The Hungry Brain: Outsmarting the Instincts That Make Us Overeat".

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